OVER THE PAST THREE YEARS, Sarah has been home alone a lot, recovering from surgery on her fallopian tubes or from other infertility treatments. She's spent hours watching TV alone in the empty house.

"It's hard seeing the commercials," she says. "During the day you have all the baby commercials."

Sarah, 31, is a homemaker who sometimes helps her husband Ben, 33, with his real estate work. They live in a comfortable house in a southern California suburb with two big, friendly dogs. Over the years, they've watched as Sarah's sisters had children. They tried to have their own, but couldn't. Sarah's eyes fill with tears as she tells of praying for a baby, dreaming at night of a baby who would look just like Ben.

"It was heartbreaking," Sarah says, "because it was like, why us? We're so perfect. You know, we love each other so much, and there's so much we had to offer, and we couldn't."

Infertility patient Sarah talks of how painful it was to her when
her sisters had children and she couldn't.LISTEN

Sarah's fallopian tubes are blocked, so the only way she and Ben can conceive a child genetically related to them is to have eggs removed from Sarah's ovaries and fertilized in a petri dish with Ben's sperm. The process is called in vitro fertilization, or IVF. A doctor transfers some of the resulting embryos to a woman's uterus. On average, a patient gets pregnant only one out of three times, so many patients try IVF repeatedly. Each attempt costs anywhere from $4,000 to $18,000 for doctors' fees, plus thousands more for drugs to stimulate the woman's ovaries to produce eggs.

To pay for treatment, Sarah and Ben have economized. "We had the real expensive cars," says Ben. "We had a boat and a couple Seadoos (personal watercraft) and we took a lot of vacation time. We liquidated all of our toys and said this is what we're committed to for the next few years."

Infertility patient Ben talks about how he and his wife, Sarah,
long for a child.LISTEN

So far Sarah and Ben have spent more than $50,000 on infertility treatment.

Because patients are willing to invest that kind of money in treatments that didn't exist a few years ago - and because about ten percent of American couples have trouble conceiving - infertility is an estimated $2 billion industry annually in the United States. Pharmaceutical companies are investing millions in fertility-related drugs. Clinic management corporations traded on Wall Street are in the business of making a profit on infertility treatment for investors. Brokers are charging fees to help couples find egg donors and surrogate mothers. And the number of U.S. clinics offering IVF has been racing upward since the mid-1980s, to about 330 today.

Infertility programs compete fiercely for patients,advertising high pregnancy rates or offering patients financial incentives. That competition worries many medical professionals, who fear doctors will use risky medical practices to try to boost pregnancy rates, or that clinics will mislead patients about their chances of getting pregnant, let alone giving birth. Some clinics quote success
rates in terms of live births, but many more, in terms of becoming pregnant - a misleading practice, some ethicists say. The chances of achieving a pregnancy through IVF hover around one in three, but some women miscarry: The chances of actually having a baby are more like one in four. University of Minnesota medical ethicist Susan Wolf says because some infertile people want children so badly, they make particularly vulnerable patients. They're "willing to undertake substantial risks and just plow forward if there's anyhope," Wolf says. "There's tremendous potential for physicians to - wittingly or unwittingly - prey upon that."

Infertility programs compete fiercely for patients, advertising high pregnancy rates or offering patients financial incentives. That competition worries many medical professionals, who fear doctors will use risky medical practices to try to boost pregnancy rates, or that clinics will mislead patients about their chances of becoming pregnant. University of Minnesota medical ethicist Susan Wolf says because some infertile people want children so badly, they make particularly vulnerable patients. They're "willing to undertake substantial risks and just plow forward if there's any hope." Wolf says, "There's tremendous potential for physicians to - wittingly or unwittingly - prey upon that."

Many doctors are disturbed by business influences on what they see as a sacred trust between physicians and patients. They want to work in a medical specialty, not an industry. Dr. Alan DeCherney, editor of the medical journal Fertility and Sterility, says the desire for profits seems to be leading to ethical lapses and even scandals, such as the widely publicized story of the California doctors accused of stealing patients' eggs and giving them to other women who could not produce their own.

"You can't go through a week without reading something in the paper about reproductive technology," DeCherney says. He says other medical specialties don't seem to have the same problems. "I don't remember a scandal about the treatment of heart disease."

DeCherney believes physicians should not be allowed to advertise. He says advertising diminishes professionalism. But many of his colleagues argue that honest advertising is perfectly ethical. And as more IVF programs open every year, more of them advertise aggressively to compete for a share of the patient market.